Symptom duration and pathologic staging of colorectal cancer

A large proportion of patients with colorectal cancer continue to present with relatively advanced and therefore incurable tumours. While delay in diagnosis is often felt to have been a contributing factor, the validity of this has seldom been questioned. Two hundred and eleven consecutive large bowel cancer patients have been prospectively studied with respect to their duration of symptoms and pathologic stage: 7.1% presented with Dukes A tumours and a mean symptom duration of 11.2 months; 38.9% with Dukes B tumours and a mean symptom duration of 4.9 months; 22.3% with Dukes C1 tumours and a mean symptom duration of 5.3 months; 3.8% with Dukes C2 tumours and a mean symptom duration of 3.9 months and 26% with stage D disease and a mean symptom duration of 3.8 months. There was no tendency for a longer symptomatic period in patients with more advanced disease. Indeed the Dukes A patients had a significantly longer duration of symptoms than those with all other stages of disease. It is argued that diagnosis at a more favourable pathologic stage would only be possible by presymptomatic tumour detection.